[Sense of hu-mor, n. points out funny actions, objects, and situations in classroom; laughs at weird moments; makes inappropriate comments; good at entertaining themselves.]

Bill Cosby has said that he doesn’t tell jokes; he takes real-life situations and finds the funny in them. As life zooms by, those of us with ADHD, have been blessed with the lightning-fast minds to do just that, find the funny in life. Comedy is a large part of my speaking presentations. I love to laugh and see people laugh. When I was a kid, I found it hard not to want to point out some of the things I saw around me, at school, at home or on the street that I thought were really funny. My desire was to spread the joy I received from noticing things that most people missed. This unfortunately caused some issues with my the subjects of my observations and especially at school, I got reprimanded a lot. A major turning point for me came when one of my teachers, who enjoyed my sense of humor, encouraged me to think about the timing and delivery of my humor.  He said, “Ben if you want people to enjoy your humor, you need to ask this question: Is this an appropriate time to be funny? If it is, then let her rip. If not, then tame the tongue.”

To this day I use that sound advice and constantly challenge myself to be serious when it is time to be serious and to be funny when it’s time to be funny. One of my favorite books says that there is a time and season for everything; I just need to make sure that I’m in the right season at the right time. Another valuable lesson I have learned regarding humor involves the appropriateness of my humor’s content. Is my joke suitable? Is there any possibility that it could be offensive to someone? Is it at someone’s expense? Being an impulsive person I have hurt a lot of people by speaking before thinking. Humor should be a tool to induce fun and enjoyment for everyone and not a tool to inflict embarrassment and pain to anyone. Sure, as a comic, I’d like to always “leave em laughin’” but never by making them cry or feel uncomfortable.

I am thankful for this teacher’s guidance and directness with me. He helped me understand how to use my sense with wisdom and sensitivity. Humor is such a powerful expression and with kind, but timely guidance and encouragement children with ADHD can certainly learn how to harness this skill to their great advantage.

If you had it to do over again, would you still give ADHD drugs to your child? About half of parents (52 percent) felt strongly that they would, according to a July 2010 survey of the parents of almost a thousand kids by Consumer Reports Health. About half (44 percent) strongly wished that there was another way to help their child besides the medication.

More parents were highly satisfied with the medication (41 percent) than felt strongly that they were concerned by the side effects of the medication (32 percent).But clearly this is a balancing act between benefits and costs.

What other strategies did parents report helped a lot?

• Changing schools to one better suited to help with ADHD (45 percent)
• Giving one instruction at a time (39 percent)
• Using a tutor or learning specialist (37 percent)
• Providing structure and schedules (35 percent)
• And seven other strategies, from changing class seats to taking fish-oil pills (12 to 27 percent)

An important key to managing ADHD is to set specific, measurable goals at home and at school. Then, when you try an intervention you can monitor progress, evaluate the treatment, and readjust the plan.

If you are considering ADHD medications, read this important brief post about long-term success and permanent side effects.

To me, the role of medications is not to “solve” ADHD, but rather one possible way to provide a window of relief and focus for a year or two in which to pursue lifestyle changes that can make a long-term difference. These might include changes in nutrition, in physical activity, in sleep, in chemical exposures, in peer groups, in study strategies, in parenting strategies, and in school environments.

Almost 40 million prescriptions were written last year for ADHD drugs in the US alone. Parents deserve to know if these drugs won’t improve the long-term success of their children. They also deserve to know if most of the kids these drugs long term will have permanent side effects. Both of these appear to be true. While these ADHD drugs may provide immediate relief of ADHD symptoms, after two years or so the kids on average are not better off than those who didn’t get the drugs at all. And those who take the drugs for three years or more appear to end up almost an inch shorter than they would have otherwise. Their growth rate slows and does not appear to rebound. These results come from a large federal study called the Multimodal Treatment Study of Children with ADHD (MTA). The latest news from this long-term study, the 8-year snapshot, was just released in the Journal of the American Academy of Child & Adolescent Psychiatry. At the beginning of the study, the children were randomly assigned to get medication alone, behavior therapy and parent training alone, medication and therapy combined, or routine community care for 14 months. At the end of the first year, those who got medication with or without the behavior therapy and parent training were doing significantly better than the others. But by three years, these differences had largely evaporated whether or not the child continued to take the medications.

Now we know that eight years later the type of treatment received initially made no difference in their long-term outcome, whether looking at grades earned in school, arrests, other psychiatric problems, or other ADHD symptoms – as assessed by parents, teachers, or the kids themselves. The specific question of substance abuse is being analyzed separately, and results are not yet available.

Some of the kids remained on the medications continuously for 6 to 8 years. Those children fared no better than those who never received meds or who used them briefly when comparing on almost all measures of success, including school grades, homework completion, quiz and test performance, school office visits, disciplinary actions, conflicts with parents, and so on. They did score a couple points higher score on a math achievement test. They also ended up shorter. Of course, these are averages. Some individuals may benefit significantly more from the medications. Or less.

To me, this suggests that when ADHD medications are used their greatest benefit would not be to “solve” ADHD, but rather to provide a window of relief and focus for a year or two in which to pursue lifestyle changes that can make a long-term difference. These might include changes in nutrition, in physical activity, in sleep, in chemical exposures, in peer groups, in study strategies, in parenting strategies, and in school environments.

“MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study.” MOLINA, BROOKE S.G. Ph.D.; HINSHAW, STEPHEN P. Ph.D.; SWANSON, JAMES M. Ph.D.; ARNOLD, L. EUGENE M.D., M.Ed.; VITIELLO, BENEDETTO M.D.; JENSEN, PETER S. M.D.; EPSTEIN, JEFFERY N. Ph.D.; HOZA, BETSY Ph.D.; HECHTMAN, LILY M.D.; ABIKOFF, HOWARD B. Ph.D.; ELLIOTT, GLEN R. Ph.D., M.D.; GREENHILL, LAURENCE L. M.D.; NEWCORN, JEFFREY H. M.D.; WELLS, KAREN C. Ph.D.; WIGAL, TIMOTHY Ph.D.; GIBBONS, ROBERT D. Ph.D.; HUR, KWAN Ph.D.; HOUCK, PATRICIA R. M.S.; the MTA Cooperative Group. Journal of the American Academy of Child & Adolescent Psychiatry. Published ahead of print, March 24, 2009. DOI: 10.1097/CHI.0b013e31819c23d0.  “Effects of Stimulant Medication on Growth Rates Across 3 Years in the MTA Follow-up.” SWANSON, JAMES M. Ph.D.; ELLIOTT, GLEN R. Ph.D., M.D.; GREENHILL, LAURENCE L. M.D.; WIGAL, TIMOTHY Ph.D.; ARNOLD, L. EUGENE M.D.; VITIELLO, BENEDETTO M.D.; HECHTMAN, LILY M.D.; EPSTEIN, JEFFERY N. Ph.D.; PELHAM, WILLIAM E. Ph.D.; ABIKOFF, HOWARD B. Ph.D.; NEWCORN, JEFFREY H. M.D.; MOLINA, BROOKE S.G. Ph.D.; HINSHAW, STEPHEN P. Ph.D.; WELLS, KAREN C. Ph.D.; HOZA, BETSY Ph.D.; JENSEN, PETER S. M.D.; GIBBONS, ROBERT D. Ph.D.; HUR, KWAN Ph.D.; STEHLI, ANNAMARIE M.P.H.; DAVIES, MARK M.S.; MARCH, JOHN S. M.D., M.P.H.; CONNERS, C. KEITH Ph.D.; CARON, MARK Ph.D.; VOLKOW, NORA D. M.D. Journal of the American Academy of Child & Adolescent Psychiatry, August 2007. 46(8):1003-10014.

Dr. Greene’s Answer:

Illnesses arise from interplay between our genes and the environment. When you look at all the conditions on the rise in kids – problems such as asthma, ADD, high blood pressure, childhood cancers, diabetes – you can’t blame our genes. These conditions have increased so rapidly in the last 30 years that we know the environment is the problem, which means that the environment also holds the answers.

As I say in “Raising Baby Green,” we are the environment. There is no separation. If a chemical exists “out there,” we should assume it’s “in here” – in our homes and in our bodies. We know there are harmful chemicals in our environment, but, as parents, we can create new healthy habits to reduce our families’ exposure to risky elements.

The diagnosis of ADHD increased 100 percent in just a decade. The percentage of kids who are overweight increased 100 percent between 1980 and 2002 (and increased 200 percent in teens). Is there a link between the two? Are kids diagnosed with ADHD more likely to be overweight? Or more likely to be underweight. It looks like the answer is yes to all three questions. A large study of more than 62,000 kids and adolescents appeared in the July 2008 Pediatrics. The children who had been diagnosed with ADHD, but were not being treated with medications, had about 1.5 times the odds of being overweight compared to their non-ADHD peers. This is consistent with other research linking ADHD and being overweight. These investigators propose that the increased weight may come from increased impulsivity and decreased self control of the kids with ADHD both leading to increased eating, coupled with more time spent watching television or playing computer or video games, leading to decreased physical activity.

In contrast, though, kids diagnosed with ADHD who are taking medications for their ADHD had about 1.6 times the odds of being underweight compared to their non-ADHD peers. Loss of appetite and weight loss are known side effects of some ADHD medications.

To me, the causes and effects of these patterns aren’t so clear cut, but it makes sense for people caring for kids with ADHD to be paying attention to their weight: they may be at greater risk of weight problems than their peers. And it makes sense to pay attention to the behavior of kids who are becoming overweight: they may be more likely to have ADHD than their peers.

Waring ME and Lapane KL. Overweight in Children and Adolescents in Relation to Attention-Deficit/Hyperactivity Disorder: Results from a National Sample. Pediatrics July 2008; 122:e1-e6.

ADHD is one of the most common behavioral and learning problems in childhood. It can affect the school experience, families, and friendships. It’s often associated with other problems as well, including learning disabilities and mood problems. Wouldn’t it be great if there were nutritional ways to help?

The relationship between what kids eat and their behavior is complex, and something we are learning a lot about in the 21st century. One emerging link is that between ADHD and other neurodevelopmental disorders with deficiencies in omega 3 fats.

Researchers in Australia, aware that EPA, DHA and other beneficial fats affect the brain, and aware that many kids get too little in their typical diets, decided to see what would happen to kids with ADHD if they got supplements of healthy fats. The results are published in the lead article of the April 2007 Journal of Developmental and Behavioral Pediatrics.

To measure the possible benefit, some kids got capsules containing EPA, DHA and other beneficial fats, while their counterparts got placebo pills containing palm oil. Their behavior was followed for 15 weeks, using the Connors Rating Scales. Those who got the supplements showed improvement in the core ADHD symptoms of inattention, hyperactivity, and impulsivity compared to their matched peers.

After the 15 weeks were up, those in the placebo group were switched to the real supplements, and they then showed similar improvement. Those who received the real supplements from the beginning continued to show sustained improvement after the full 30 weeks.

This preliminary study suggests that some children with ADHD might experience reduced symptoms if they get the healthy fats they need.

Sinn, N., and Bryan, J. “The Effect of Supplementation with Polyunsaturated Fatty Acids and Micronutrients on Learning and Behavior Problems.” Journal of Developmental and Behavioral Pediatrics. April 2007, 28, pp. 82-9

Here’s a very interesting study – the first to connect children’s iron levels and ADHD. In Paris, France, 110 children from the same school district were referred to a university hospital between March 2002 and June 2003 to be evaluated for school-related problems. Fifty-three of these children met the criteria for a definite diagnosis of ADHD. Researchers analyzed blood samples from these children and from 27 of the other children who did not turn out to have ADHD.

The stunning results were reported in the December 2004 Archives of Pediatrics and Adolescent Medicine. At their lab, a normal serum ferritin (iron) level is greater than 30 ng/ml. The average level in the non-ADHD kids was normal at 44 ng/ml. But the average serum ferritin in the children with ADHD was about 22 ng/ml . about half that of the other children! Fully 84 percent of the children with ADHD were iron deficient with ferritin levels less than 30 ng/ml.

More strikingly, the lower the serum ferritin was in this study, the worse the ADHD symptoms . worse hyperactivity, worse oppositional behavior, and worse cognitive scores. But none of the children had anemia from their iron deficiency. They all tested normal on the hemoglobin or hematocrit blood tests used in doctors’ offices to screen for iron problems! But, when other researchers gave appropriate iron supplements to children with ADHD, their test scores and ADHD symptoms improved.

This all makes some sense. Increasing evidence links ADHD to inadequate function of a neurotransmitter called dopamine. Medicines that stimulate dopamine activity improve ADHD symptoms. Adequate iron is needed by the body both for making dopamine and for the proper functioning of dopamine receptors. Beyond this, there is ample solid evidence showing that low iron levels in children cause learning and behavior problems, especially if the low levels are present during key windows of development. We also know that restless leg syndrome is often connected to iron deficiency.

Therefore, even though this pioneer study linking low iron levels with ADHD is small and has yet to be repeated in other children, there are good reasons to take it seriously. Even though the answers are not all in, if I had a child with ADHD, I would consider obtaining a serum ferritin test, consider whether his or her diet would supply ample iron, and consider supplementing with an appropriate amount of iron. Having normal iron stores is unlikely to hurt a child, and could offer a significant benefit.

A recent study has changed my thinking about ADHD, and I hope it changes the way that all children with ADHD are evaluated and treated. And that parents are treated. Parents deserve better understanding and support than they traditionally get. Dr. Andrea Chronis and her team at the University of Maryland make a compelling argument that whenever children have ADHD, getting help for their parents should be thoughtfully undertaken.

ADHD tends to run in families. In the Maryland ADHD Program study of 214 children, the parents of children with ADHD were 24 times more likely to have ADHD themselves than were parents of children without ADHD. These results were published in the December 2003 Journal of the American Academy of Child and Adolescent Psychiatry. As is often the case, many kids in the study also had Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) in addition to their ADHD. Their parents had higher rates of depression and other psychological problems, including alcohol and other types of substance abuse.

Is this genetic? Or might it result from the increased stress of dealing with ADHD? Both are probably true to some extent. Significantly, all treatments for ADHD tend to be less effective when the parents have their own psychological issues. It makes sense that parent with ADHD might be less able to make needed environmental changes. Even medications, however, are less effective when the parents. problems are untreated. This has important implications.

Whether or not parents have symptoms of their own, they are likely to be under great stress. Dealing with a child with ADHD can be exhausting, frustrating, and embarrassing (as well as creative, energizing, and delightful). Listening to parents and offering practical support should start at the beginning of an ADHD evaluation and continue through the course of treatment. The treatment plan should be developed with this in mind.

‘Medications alone are not sufficient to treat ADHD,’ Dr. Chronis emphasized when we spoke about her study. ‘We need to look beyond the child to recognize and treat the parents’ issues,’ for their own sakes and for the sakes of the children. Dr. Chronis is the director of the Maryland ADHD Program.

When treating obesity in children, I know that success is most likely if the whole family eats healthier and spends more time being active . even if only one child is obese. It makes deep sense to me that family changes would also have the greatest impact in ADHD, even if parents don.t have psychological issues. If parents do have ADHD or are depressed, it makes sense that success in the children would be extremely difficult without helping everyone.

I hope I never look at a child with ADHD in isolation again.

Dr. Greene’s Answer:

The most common side effects of Ritalin overall are nervousness and insomnia. In children, trouble with appetite and stomachaches can be even more common. If the stomachaches continue, you will want to report them to your doctor.

If Ritalin is the cause you might want to consider adjusting the dose or changing medications–though sometimes it can be continued as-is. I’m glad you asked this question–many parents don’t know that stomachaches can be a common side effect of Ritalin.

Dr. Greene’s Answer:

With kids who are disruptive, working on empathy can be very helpful–not telling her what to do, but helping her learn to identify what others are feeling (which can lead to changes in behavior).

It is also good to keep in mind–especially if it runs in the family–that if ADHD shows up at that age, the most common symptoms are the ones you have described. It may be worth an evaluation by her pediatrician.